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Academic Health Centers Must Change or Risk Irrelevance Warns Annals of Family Medicine Supplement
Departments of Family Medicine May Hold Solution
Media Contact:
Kristin Robinson
American Academy of Family Physicians
(800) 274-2237 ext. 5221
(202) 249-4099 (Sept. 27 – 30)
kristinr@aafp.org
LEAWOOD, Kan. – The nation’s 126 academic health centers (AHCs), which train a considerable portion of today’s health care professionals, conduct important research and provide substantial amounts of clinical care, especially to underserved and uninsured populations, are falling short of their responsibilities amid a changing health care landscape. Departments of family medicine are uniquely positioned to play a leadership role in the revitalization of AHCs to ensure they remain relevant to society’s most pressing needs.
This is the conclusion of a special supplement to the September/October issue of Annals of Family Medicine, “Shaping the Future of Academic Health Centers: The Role of Family Medicine Faculty and Departments,” developed by the Association of Departments of Family Medicine (ADFM), in collaboration with six family medicine organizations. The supplement features five case studies and accompanying commentaries that showcase best practices from five AHCs in five key areas: 1) ambulatory and primary care 2) indigent care 3) education in community and international settings 4) workforce policy and practice and 5) translational research. The case studies demonstrate how departments of family medicine have contributed to and provided leadership in the necessary transformation of AHCs.
Background provided in the supplement explains how medical schools and teaching hospitals form a critical component of our nation’s medical safety net, a role that comes at an enormous cost for AHCs. Although teaching hospitals represent 6 percent of the nation’s hospitals, they provide more than one half of the nations charity care. The Association of American Medical Colleges (AAMC) reports that the cost of this care in 2003 was $5.9 billion. The authors explain that the AHCs social and historic mission to provide care to indigent and underserved populations is being severely challenged by this financial burden, coupled with a health care landscape of increased competition, managed care and declining resources.
At the same time, AHCs as they are set up today, contribute to many of the failings of the U.S. health care system. The concentration of resources by AHCs value cure rather than prevention, subspecialization rather than generalism, fragmentation of care rather than integration and career advancement rather than community responsiveness.
The prominence of AHCs and the many physicians they produce have resulted in the values of AHCs dominating the values of U.S. medicine.
The authors assert that family medicine, with its emphasis on prevention, generalism, integrated care and community-based research can help lead in changing the direction of AHCs. Family physicians have more patient visits annually than general surgeons, pediatricians and obstetricians-gynecologists combined, and large majorities of patients with each of the most common chronic diseases identify a family physician as their usual source of care. They are the largest single group of physicians, exceeded only by the combined subspecialities of internal medicine.
In an accompanying editorial, guest editor and ADFM President, Warren P. Newton, M.D., M.Ph., asserts that family medicine can help lead renewal of the AHC by pushing for substantial change; by helping the revitalization of the relationship between AHCs and the communities they serve across all missions; and by emphasizing fundamental innovation in clinical care, teaching and research. He points out that as the rate of the uninsured and underinsured continues to rise, it is paramount that academic health centers continue to prosper and make the changes necessary to remain a relevant contributor to the United States health care system.
“Academic health centers are a public good that must evolve substantially to meet the needs of patients and our society,” said Newton. “Their experience with broad patient populations, expertise in ambulatory care and quality improvement and a track record of innovation in education and research in the community, family medicine departments can play a major role in making the appropriate changes happen.”
AHCs are health centers that include a medical school and a teaching hospital, usually associated with health professional schools and are often located within communities of underserved populations and care for the medically indigent and vulnerable populations. Seventy-five percent of the nations 126 AHCs are seated within communities of underserved populations. Caring for these populations is a key component of the mission of AHCs.
Academic health centers enjoyed three decades of expansion as the result of federal support for clinical care and research. The emergence and rapid growth of managed care in the early 1990s put these centers at a marked disadvantage when competing for insured patients. Today, AHCs grapple with adapting to trends such as the change in patient needs due to an aging population, rapid immigration and the rise in chronic disease, financial streams supporting education and research coming under threat and a change in marketplace dynamics creating increased competition.
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About the Association of Departments of Family Medicine
The Association of Departments of Family Medicine (ADFM) is an organization of 135 member family medicine departments in the United States, including departments from eleven large regional medical centers and five osteopathic schools. ADFM’s purpose is to promote the philosophy and interests of family medicine in medical schools, to further the efficient and effective administration and operation of academic departments, divisions, and sections of family medicine for the benefit of society, faculty, students and institutions; and to support research and scholarship within departments, divisions, and sections of family medicine in United States and Canadian medical schools.